Prediabetic Neuropathy: Diagnosis and Treatment.

With estimates of the incidence of prediabetes in the USA at over 84 million people, prediabetes is an epidemic by any definition.  It is also one of the leading causes of peripheral neuropathy with some 18% of prediabetics–15 million people in the USA–estimated to be suffering from peripheral neuropathy.

Because diabetic and prediabetic peripheral neuropathies are both the result of glucose dysregulation, it is not surprising that they present similarly.  The neuropathy of prediabetes is a small fiber neuropathy characterized by burning, tingling, numbness, and shooting pains, starting in the toes and ascending over time up the feet and legs in a length dependent, symmetrical fashion.

The diagnosis of prediabetes can be determined by running a HbA1c and/or an oral glucose tolerance test.  Small fiber neuropathy can be diagnosed by performing an intraepidermal nerve fiber density biopsy.  As always, a detailed history and physical should be performed.

Prediabetic peripheral neuropathy should be treated in a similar manner as diabetic peripheral neuropathy.  Lifestyle changes including exercise and diet modifications should be strongly suggested to prediabetics.  Consider recommending a diabetic counselor.  Appropriate shoes and orthoses should be recommended to protect feet with decreased sensitivity.  Physical therapy should be considered in order to reduce fall risk.  Benfotiamine and vitamin B12, when used properly, have proven to be very helpful in reducing symptomatology.  Other B vitamins, alpha lipoic acid, evening primrose oil, and other nutrients may prove helpful.  In more severe cases, the use of analgesics, anticonvulsants and antidepressants may be necessary.

A request from the author:
Have any of your patients who have taken NeuRemedy experienced any benefits in addition to improvement in their neuropathic symptoms? If so, I would like to know. Please contact me at or call me at 561-549-9099.

Dr. Mann bust-shotDr. Richard H Mann, DABPS, ret
Chief Scientific Officer & Founder, Realm Labs

If you would like to speak with Dr. Mann about how to improve your outcomes in the treatment of polyneuropathy call 866-634-2745 or email Dr. Mann at

Dr. Mann is the developer of the  NeuRemedy®line of benfotiamine nutritional supplements. NeuRemedy is a safe, proven, and effective nutritional formulation dispensed by physicians to their patients suffering from numbness, tingling, burning and/or shooting pains in the feet and legs.  Thiamine (vitamin B1) deficiency often accompanies and intensifies these symptoms. The reversal of thiamine deficiency is an important therapeutic goal in the management of these patients.*

The key ingredient in NeuRemedy, benfotiamine, is the most highly bioactive oral form of thiamine available. It rapidly and safely reverses thiamine deficiency, improving the functioning of the nerves in the feet and legs. Each capsule of NeuRemedy contains 150 mg of benfotiamine in a proprietary formulation. Because of its impressive success rate and high safety profile, NeuRemedy was recently licensed in Canada as an important factor in supporting healthy nerve function in individuals with polyneuropathy.*

NeuRemedy is the leader in the field with thousands of physicians and patients relying each day on its efficacy, purity, safety and rapid onset of action.*

For more information on NeuRemedy:
In the USA contact Realm Labs at 866-634-2745.
In Canada contact OHI at 855-561-4156.

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